Text: H05775 Text: H05777 Text: H05700 - H05799 Text: H Index Bills and Amendments: General Index Bill History: General Index
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PAG LIN
1 1 Amend the amendment, H-5102, to House File 2298 as
1 2 follows:
1 3 #1. Page 1, line 3, by striking the word "clause."
1 4 and inserting the following: "clause, and inserting
1 5 the following:
1 6 "Section 1. NEW SECTION. 514C.11 PATIENT ACCESS
1 7 TO TYPES OF PHYSICIANS UNDER MANAGED CARE HEALTH PLAN
1 8 OR INDEMNITY PLAN WITH LIMITED PROVIDER NETWORK.
1 9 Notwithstanding section 514C.6, a managed care
1 10 health plan or indemnity plan with a limited provider
1 11 network shall provide patients direct access to each
1 12 type of physician, as defined in section 135.1 and
1 13 licensed under chapter 148, 150A, or 151. Such direct
1 14 access to a physician licensed under chapter 151 shall
1 15 not be conditioned upon a referral by a provider
1 16 licensed under another chapter. Access to a
1 17 specialist may be conditioned upon a referral by a
1 18 primary care provider physician licensed under chapter
1 19 148, including a pediatrician, 150A, or 151. If a
1 20 physician licensed under chapter 151 determines that a
1 21 referral should be made to a physician licensed under
1 22 another chapter, a managed care health plan or
1 23 indemnity plan with a limited provider network may
1 24 require that the referral be made first to a provider
1 25 designated by the plan. Any copayment deductible,
1 26 cost containment mechanism, or premium rate shall not
1 27 discriminate directly or indirectly upon the basis of
1 28 the license held by the physician. Access to a
1 29 specialist may be subject to a different copayment or
1 30 deductible than access to a primary care provider.
1 31 Access to a nonparticipating physician may be
1 32 restricted or may be subject to different copayments,
1 33 deductibles, or premium rates, or may be excluded,
1 34 provided that a plan shall not differentiate or
1 35 exclude a physician directly or indirectly upon the
1 36 basis of the license held by the physician.
1 37 Each plan must demonstrate that it is capable of
1 38 serving appropriately the needs of the subscriber
1 39 population in the service area of the plan with regard
1 40 to patient access to each type of physician. The
1 41 commissioner of insurance shall adopt rules as
1 42 necessary to administer this paragraph.
1 43 For purposes of this section, "managed care health
1 44 plan or indemnity plan with a limited provider
1 45 network" means a health maintenance organization,
1 46 organized delivery system, accountable health plan,
1 47 health care insurance plan which limits the number of
1 48 licensed physicians who can provide services under the
1 49 plan, preferred provider organization, exclusive
1 50 provider organization, restricted access network, or
2 1 similar health-care plan. For purposes of this
2 2 section, "physician" means physician as defined in
2 3 section 135.1 and licensed under chapter 148, 150A, or
2 4 151.""
2 5
2 6
2 7
2 8 GRUNDBERG of Polk
2 9 HF 2298.249 76
2 10 mj/jj
Text: H05775 Text: H05777 Text: H05700 - H05799 Text: H Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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